Keeping Women Heart-Healthy

Tufts School of Medicine professor Dr. Richard Karas recently spoke about ways to prevent the onset of heart disease and other ailments in women.

Boston [06.21.05] Thanks in part to the work of Tufts' Drs. Alice Lichtenstein and Miriam Nelson and their book Strong Women, Strong Hearts, the issue of heart disease in women is gaining needed national attention. They are not alone among Tufts health experts in urging women and men alike to get healthier and avoid the risk of heart disease.

"Part of the problem in this whole area is that so much of what people commonly think about heart disease was really derived from studying men," Tufts' Dr. Richard Karas explained to National Public Radio. "So the idea of the kind of crushing chest pain maybe radiating down the left arm, etc. — that's really much more typical in men."

Karas is director of the Preventive Cardiology Center at Tufts-New England Medical Center, directs the medical center’s Women’s Heart Center and co-directs of the Molecular Cardiology Research Institute.

Signs in women, as Friedman School of Nutrition Science and Policy professors Nelson and Lichtenstein detail in Strong Women, Strong Hearts, are more subtle – such as nausea or breathing difficulties.

But not enough women or doctors are focused on the correct warning signs. The problem, Karas noted, has fatal repercussions.

"Though the rates of heart-disease death have been declining in men over the last several years, that same success has not been found in women," he told NPR. "It is clearly impacted by the lower rates of aggressive treatment in women. Women don't consider themselves to be at risk for heart disease, so they don't tend to be as interested in the preventive measures that they could be and should be."

One treatment possibility mentioned by Karas was hormone therapy, which he explained has been studied with mixed results. Some scientists, the Tufts professor explained, have speculated that an older woman's increased risk of heart disease stems from the halt in estrogen production caused by menopause – thus spawning the idea that perhaps a postmenopausal infusion of estrogen could continue to lower the risk of heart disease.

"The clinical studies that have looked at that in the last several years have produced a lot of controversy and a lot of confusion," Karas explained. "We had a whole series of studies initially that suggested that women who took hormone replacement therapy post-menopause had a reduction in heart disease. More recently, the randomized trials, which are really considered the gold standard in clinical medicine, in a population of older women did not show any benefit of estrogen on heart disease. And, in fact, in some groups, there appeared to be an increase in heart disease with estrogen use."

Still, he expressed optimism about sorting out the role of estrogen in women for heart disease. "With time and consideration, there are some important ideas that are coming forward about what those differences might be."

Another threat for heart disease, the Tufts physician said, is the onset of diabetes.

"The impact of developing diabetes on heart disease risk is considerably higher in women than it is in men," Karas told NPR’s “Talk of the Nation – Science Friday” program. "For a man and a woman of the same age, the woman typically has a lower risk of heart disease than the man. If she develops diabetes, that basically takes away that protection of being a woman, and her rate of heart disease becomes equivalent [to that] of a man of about the same age."

The key to prevention, Karas says, is starting healthy habits at a young age.

"There's a lot of information that suggests that youngsters who are overweight turn into adults who are overweight. And that is the leading cause of diabetes in this country," he told NPR.

Overall, Karas urged people – both men and women – to be mindful of their health in order to stave off heart disease.

"Half the people who die from heart disease die right off the bat, no warning," he explained to NPR. "And that's a very, very important reason for all individuals to be aware of common preventive measures to reduce their risk of having heart disease, because you don't always get a warning to let you know that that's a problem."